Collaborative care: a new model for a new century

From the imagined vantage point of the year 2020, the author recounts the problems and deficiencies of health care in the 1990s and describes how academic medicine's leaders successfully confronted them. A key part of their strategy was to work together to form a coordinated network of medical schools, teaching hospitals, and academically oriented health systems, along with their staffs and a variety of community-based partners. In this way, they set a national agenda, pursued common goals, freely shared information and best practices, and cooperated to optimize their effectiveness in education, research, and clinical care. A major outcome of this new network was the Collaborative Care model of health care, based on the premise that a basic purpose of the health care system is to achieve measurable improvements in the health of individuals and communities in ways that are cost-conscious, quality-driven, evidence-based, and patient-, family-, and community-oriented. Academic institutions formed strong partnerships with many stakeholders (e.g., purchasers of health care services) to make the Collaborative Care approach work. In addition, there were several other important keys to Collaborative Care's success, such as the full integration of clinical research with clinical care and the restoration of trust in the health care enterprise. The author returns to reality and the 1990s. He challenges academic medicine to pursue the Collaborative Care vision, saying that "we should not accept without challenge what we know to be abominable just because it appears to be inevitable.... Our choice is to continue to struggle for survival as the environment around us gets harsher and harsher ... or to fix the environment" using the power of collaboration to unleash academic medicine's unlimited creativity and wisdom.